Provider First Line Business Practice Location Address:
2407 NAMPA CALDWELL BLVD
Provider Second Line Business Practice Location Address:
NO. 168
Provider Business Practice Location Address City Name:
NAMPA
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83651-1515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-562-2200
Provider Business Practice Location Address Fax Number:
208-562-2207
Provider Enumeration Date:
08/11/2011